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Veterans Affairs Cooperative Asymptomatic Study
• 1983-1991; published 1993 in NEJM.• Randomized 444 asymptomatic men with 50-99% stenosis
CEA/ASA or ASA.• Endpoints: TIA, stroke or death• After a mean of 48 months the incidence of all ipsilateral
neurologic events -- 8.0% surgery vs. 20.6% medicine (p<0.001). Ipsilateral stroke alone -- 4.7% surgery vs. 9.4% medicine. Stroke and death -- 41.2% vs. 44.2%. Both ns.
• Perioperative stroke - 2.4%; Death - 1.9%• Criticized for small numbers and for counting TIA as
outcome equivalent to stroke.